The recently released final rule on meaningful use of electronic health records strikes a good balance between quick adoption and a recognition of the challenges that adoption creates for many healthcare providers, Dr. David Blumenthal, the national health IT coordinator, told a Congressional panel this week.
Blumenthal defended the final rule against what some see as too undemanding requirements for meaningful use. Rep. Wally Herger (R-Calif.) claimed that "by watering down the final regulations we have missed an opportunity" to improve patient care and reduce waste of taxpayer funds.
Herger is a member of the House Ways and Means Committee. That committee's health subcommittee held a hearing July 20 on efforts to promote the adoption and meaningful use of health IT.
Blumenthal countered that the next stage of meaningful use in 2013 will hold providers to more stringent requirements, including more robust health information exchange.
"Our approach to meaningful use must be both ambitious and achievable," he said at the hearing, adding that the speed of adoption must "reflect both the capacities of the providers and the maturity of the technology."
The meaningful use final rule, which the Centers for Medicare and Medicaid Services released July 13, reduced the number of requirements and added flexibility to achieve some of the criteria compared with the proposed rule published in January. CMS also decreased the level of achievement of some measures, such as reducing the amount of electronic prescribing from 75 percent to 40 percent of prescriptions.
Providing a practical view, Dr. Eugene Heslin, lead physician at Bridge Street Medical Group in Saugerties, N.Y., told the subcommittee members that meaningful use incentives can persuade physicians to make the decision to move forward to benefit their patients and community.
Heslin established electronic health records in his practice in 2006 with financial assistance from the New York State Department of Health and technical support from regional health IT organizations. His practice adopted the medical home model in 2009 for more coordinated care of patients with other local practices and received incentives for demonstrating improved quality paid for by six local health plans and a large employer, IBM.
"I can tell you that incentives are useful to engage physician interest and offset some of the costs of health IT adoption and meaningful use," he said. "Meaningful use has provided a focus to move towards and something to make it happen. Without it, we simply couldn't get it done..
Rep. Herger questioned whether the federal government's meaningful use incentive of $44,000 for physicians was too high when physicians in New York, like Heslin, implemented EHRs with $8,300 in incentives "to get them going."
Heslin said that the New York incentives were primarily for the EHR license and implementation efforts. "It didn't get us to meaningful use, which is a different set of criteria," he said.
He has spent far more than the incentive for the time his staff spent putting the process in place, in workflow redesign to be able to get to some of these meaningful use criteria, in training his nurses, and in sufficient Internet access. He tried three different methods to get his records connected.
"I finally went to a server approach that combined two different forms of Internet access to be able to get the system up to run," he said. "That costs me about $1,000 a month."
